*

* : 29

Respiratory Diseases of the Newborn*

(nasal flaring) (Granting) (Gasping) 60+/-

: : CNS

Neonatal Respiratory Distress EtiologiesPulmonarycausesRDSPneumoniaTTNMASOther aspiration syndromeAir leak syndromeLung hemorrhageLung hypoplasiaCongenital malformations

SystemiccausesInfectionsMetabolic causesTemperatureAnemia PolycythemiaCongenital heart diseasePulmonary hypertensionNeuromuscular disorderAnatomic causesUpper airway obstructionAirway malformationSpace occupying lesionRib cage anomaliesPhrenic nerve injury

Neonatal Respiratory DistressAlgorithmRespiratoryDistress(tachypnea, retractions, grunt)

Preterm Term

< 6hrs old > 6hrs old < 6hrs old > 6hrs old

HMD (RDS)PneumoniaLung anomaly

PneumoniaCHDPul. HemorrhageTTNMAS/PPHNAsphyxiaLung anomalyAir leak

PneumoniaCHD

(TTN) (RDS) (MAS) (PAL) (PPHN) (CDH)

5.71000 :

40 CPAP 48-24 72

TTN

X-rayFluid in the fissure

80-60 28 30-15 36-32 5 37 : 6

:( ) ( BCABC A3) :

/ . : Fio2

PathogenesisPrematurityPrenatal asphyxia Reduced surfactant synthesis, storage, releaseIncreased alveolar surface tensionProgressive atelectasis DiffusionUneven V/QHypoventilationgradientHypoxemiaCO2 retentionAcidosisPulmonary vasoconstriction HypoperfusionCapillary endothelial damagePlasma leak Fibrin

V/Q CO2

: :

(1/5-1/10)

(): 6 . . 5-3 .

RDS

RDS*

() 34-24

() PDA (BPD) (IVH)

MASMSAF24-5 MAS5MSAF 40-5 : 41 SGA .

MAS

*

34 . .

: ( 34) : ( )

MAS Intra partumPH *

PPHN

: Over inflation Chest

*

MAS

MAS*

Management of MSAF PH

Management of MSAF FHR *

Intra partum 12 14 ( ) : vigorous or depress

1 10 LBW PROM GBS . . .

*

: NST GBS :GBS ...

mottling RDS

*

Pneumonia/ Sepsis*

Fetal Circulation*

FO TR (RDS,MAS,CDH,) .

. : ECMO

*

PPHN

This chest radiograph shows nosignificant pulmonary pathology.There is decreased vascularity withmild cardiomegaly. There is severerespiratory distress and cyanosis,and the response to oxygen is initiallypoor.

2 6-2 :MAS,RDS,CDH : PIE

. tap . chest tube .

()

.

. .

Sail sign

1/2000-1/4000 :

: ECMO PPHN

*

CXR

CDH

PPHN .

(BPD): 36 PCA: :PDA

(BPD) : : : ( )

*

BPD

( ) *

: ( ): PDA,ASD,VSD ,PFO(

*

PPHN ASD,VSD,PDA *

(): : 70

*

: HR

*

: PaO2 100 10 30-20 10 : PPV CO2 ( PPHN )*

Respiratory AssessmentTachypneaApnea, irregular breathing patternGruntingRetractionsNasal flaringColorful secretionsRales, rhonchiCyanosis*

Spo288-95

ACORN 5 4 5-8 4

ACORN 8

ACORN : 27 40 50 .

NICU CPAP

Scenario Baby Boy SNo prenatal care. Uneventful delivery vaginal delivery. APGARS 8 and 9 at 1 and 5 minutes, respectively. Infant taken to newborn nursery and given routine care. Eyes and thighs done, bath completed. VSS. Looking good and smelling nice. Infant went out to mother to breast feed and you have been summoned to check on baby.*

*

ScenarioUpon arriving in the mothers room, you begin assessing infant.Babys color is rather blue.TachypneicRR 70s to 80sBulb sx and get a little bit of colostrum.Retractions and Grunting presentBabys temp is 35.9What will you do?*

ScenarioTake infant back to nursery for observation and monitoring.Place infant on O2 if sat < 90-92 depending upon your policy.Place infant under radiant warmer.Obtain a full set of vital signs.RR 80sRetracting, nasal flaring, gruntingHR 180with murmurBP 42/30 with MAP 36SaO2 on 100% blow by 88%

*

Scenario5. Colordusky6. CRT 4 seconds7. Poor peripheral pulses*

ScenarioCALL MD if you havent alreadyContinually reassess infant.With your next assessment: VS have not changed much. Infant continues to grunt, retract and have nasal flaring. Sats 86.

*

ScenarioWhen auscultating, you notice that the heart tones are now more midline than on left. You also notice that when auscultating the left lung that you thought you heard gas bubblesWhat do you want to do?What do you suspect this infant has?*

ScenarioSTAT CXRIntubate infant and ventilatePlace large bore Anderson/ Replogle tube to continuous low suctionGive fluid bolus (and more if needed)Probably start pressorsDo what needs to be done to stabilize this infant and call for transport*

Take AwayDont be afraid to think out of the boxWe continually see funky thingsDo no harm this is someones baby*

*

*******White out , no heart borders*Aeration vs atelectasis**